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Questions and Answers
What is the preferred drug for managing ephedrine overdosage?
Which of the following is NOT a clinical feature of organophosphate poisoning?
What is one of the first principles of management in an organophosphate poisoning scenario?
Which of the following actions is part of reducing absorption in organophosphate poisoning management?
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Which anti-cholinergic drug is recommended for managing organophosphate poisoning?
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What class of compounds does Ecothiophate belong to?
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Which of the following symptoms indicates cholinergic crisis in organophosphate poisoning?
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What role does activated charcoal play in the management of poisoning?
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What is the role of Pralidoxime in the treatment of organophosphate poisoning?
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Which of the following is true regarding the administration of Atropine in organophosphate poisoning?
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What does the 'aging' of Cholinesterase refer to in the context of organophosphate exposure?
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Which of the following parameters should be monitored during the treatment of organophosphate poisoning?
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Why should Pralidoxime be given as soon as possible after organophosphate exposure?
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How do organophosphate compounds affect acetylcholine levels in the nervous system?
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What is the target systolic blood pressure (SBP) during treatment for organophosphate poisoning?
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What physical examination finding is expected in a patient adequately treated for organophosphate poisoning?
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What can excessive acetylcholine (ACh) in the central nervous system lead to?
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What is the role of cholinesterase testing in relation to organophosphate poisoning?
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Which benzodiazepines are commonly used as anticonvulsants for treating convulsions in organophosphate poisoning?
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When is a patient typically observed for intermediate syndrome after organophosphate exposure?
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What monitoring approach is NOT used for organophosphate poisoning?
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Which symptom indicates rapid onset and severe progression in organophosphate poisoning?
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What condition may arise from excess acetylcholine leading to seizures?
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What should be monitored in patients who have been exposed to organophosphate poisoning?
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Study Notes
Management of Ephedrine Overdosage
- Gastric lavage and activated charcoal are used for managing ephedrine overdosage
- Labetalol is the preferred medication for ephedrine overdosage management, while esmolol can be used as an alternative
- Ephedrine overdosage can lead to increased heart rate and blood pressure
Principles of Organophosphate Poisoning Management
- Organophosphates inhibit acetylcholinesterase, leading to an accumulation of acetylcholine in the synapse
- ToXIL was used to treat glacuna
- Organophosphates are categorized as pesticides and nerve agents, with examples including Ecothiophate, Parathion, Malathion, Tabun, Sarin, and Soman
Clinical Features of Organophosphate Poisoning
- Organophosphate poisoning results in muscarinic and nicotinic effects
- Muscarinic effects include diarrhea, urination, miosis, bradycardia, bronchospasm, emesis, lacrimation, and salivation
- Nicotinic effects include mydriasis, tachypnea, weakness, tachycardia, muscle fasciculations, and muscle weakness
Organophosphate Poisoning Management
- ABCD approach: Airway, Breathing, Circulation, Decontamination/Drugs
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Decontamination/Drugs:
- Prevent/reduce absorption: Wash skin, eyes, and hair with soap and water, remove contaminated clothing, gastric lavage
- Anti-muscarinic drug: Atropine sulfate (2-3mg IV stat and monitor every 10-15 minutes)
- Cholinesterase reactivators: Pralidoxime (immediate administration)
- Anticonvulsants: Benzodiazepines (lorazepam, diazepam) for seizures or coma
Cholinesterase Reactivators
- Pralidoxime reactivates the cholinesterase enzyme that is inhibited by organophosphates
- Pralidoxime should be administered before the enzyme ages, as aging makes the enzyme less responsive to reactivation
- Aging refers to the irreversible formation of covalent bonds between the organophosphate compound and acetylcholinesterase
Anti-Cholinergic Drug Monitoring
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Target goals:
- Systolic blood pressure (SBP) > 90 mmHg
- Heart rate > 110/minute
- Clear lung fields
- Pupils in mid position
- Bowel sounds present
Acetylcholine in the Central Nervous System
- Organophosphate compounds can easily cross the blood-brain barrier due to their lipophilicity
- Excess acetylcholine in the brain can result in convulsions or coma
Laboratory Tests for Monitoring
- Plasma cholinesterase: Synthesized by the liver, not used for monitoring OP poisoning
- Red blood cell (RBC) cholinesterase: More accurately reflects the enzyme in the neuronal synapse, used for monitoring OP poisoning
Intermediate Syndrome
- Intermediate syndrome can occur 24-96 hours after OP exposure
- Characterized by rapid onset of severe muscle weakness that progresses over 4 days
- Patients should be monitored for the first 4 days after OP exposure
Discharge Criteria
- Patients can be discharged from the hospital when they are stable and symptoms have resolved.
- The decision to discharge should be made by a physician and should be based on clinical criteria.
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Description
This quiz covers the management strategies for ephedrine overdosage and the clinical features of organophosphate poisoning. It highlights the use of gastric lavage and medications like labetalol for ephedrine overdose, as well as the effects and treatment of organophosphate poisoning. Test your knowledge on these critical clinical scenarios.
